Civil Society expects Minister to vote Yes on memorandum to recognize Drug Resistant TB (DR-TB) as a Public Health Emergency at 4th SA TB Conference on 13 June 2014

Civil society organizations the Treatment Action Campaign, SECTION27 and Médecins Sans Frontières have issued a memorandum to the 4th SA TB Conference calling for TB and DR-TB to be declared a public health emergency and for the response to TB to be significantly geared up to address the crisis of DR TB in particular.

The majority of the 1 200 delegates of the conference have already voted to endorse the memorandum and we expect that many more will vote before the close of the conference on Friday morning.

This represents a mass appeal from the most prominent figures and organisations in science, medicine and civil society, all of whom have agreed that TB and DR TB are a public health emergency that must be confronted with our best efforts and resources to curb preventable new infections and continuing deaths.

A number of key figures have already voted in support of the memorandum, including prominent people in the human rights, science and medical fields; heads of prominent organisations; and individuals such as Conference Chairperson Prof Bavesh Kana; MEC of Health for KwaZulu-Natal Dr Sibongiseni Dhlomo; and International Federation of Red Cross and Red Crescent Societies TB Goodwill Ambassador Gerry Rantseli-Elsdon.

We hope that the Minister of Health, Dr Aaron Motsoaledi, will add his “yes” vote tomorrow morning when he addresses the closing plenary of the 4th SA TB Conference.

The full text of the memorandum is copied below:

VOTE YES TO STOP TB and DR-TB

Activist statement to the 4th SA TB Conference

Call for TB and DR-TB in SA to be declared a Public Health Emergency in South Africa

Dear TB Conference 2014 Delegates,

We know that TB is a preventable and treatable bacteria that can be beaten. We know that TB control has been prioritised in the National Strategic Plan for HIV, STIs and TB 2012-2016, which aims to cut incidence and mortality by half.

Yet in South Africa:

– TB mortality is the leading cause of death in adults and children. Latest figures show that 18% of natural deaths recorded in 15-49 year olds were due to TB (this figure is separate from HIV). TB is also the leading cause of natural death in prisons.

– There are 1 400 new TB infections every day. The NSP target is at least half of this.

– The South African National AIDS Council estimates that we are R2.6-billion short on funding for the NSP and that this will increase to R5-billion over the next three years.

– TB mortality is the leading cause of death in adults and children. Latest figures show that 18% of natural deaths recorded in 15-49 year olds were due to TB (this figure is separate from HIV). TB is also the leading cause of natural death in prisons.

– Mortality in multi-drug resistant (MDR) and extensively drug resistant (XDR) TB is much higher (almost 50% of all diagnosed XDR patients died in 2010). It costs at least approximately R40 000 to treat DR TB versus approximately R200 to treat drug susceptible TB.

– GeneXpert currently only diagnoses rifampicin resistance whereas some TB is known to be resistant to other drugs. There are other good and effective diagnostics that must be procured.

– The incidence and prevalence of MDR TB is rising uncontrolled, the scale of XDR TB is still unknown and there is growing evidence that DR TB is being increasingly transmitted directly between people: we are not in control of DR TB!

– Massive overcrowding and poor access to treatment in prisons, conditions in mines, informal dwellings, schools and some forms of public transport ensure that we continue to incubate and spread TB throughout our communities. These conditions, still largely unchallenged, create conditions likely to drive the spread of DR-TB.

– TB monitoring and data collection and analysis is very poor locally and nationally and is not being used effectively to improve patient care.

– The Department of Health has devised good policies to address DR-TB. But implementation by provinces is generally very poor and the success of the response to DR-TB and TB is falling through large gaps in the system.

– There seems to be no political accountability in the provinces.

– The failure of the DoH to properly employ, train, supervise, support and monitor community heath care workers is making TB testing, adherence and contact tracing almost impossible.

South Africa faces a choice. We can continue to let people die of preventable TB or we can act with urgency and determination to defeat it. In particular, we can and must halt DR-TB.

In HIV, the tide was turned when, eventually, HIV was recognised for what it is: a threat to life on a massive scale requiring a response on a massive scale. We need a similar response to DR-TB.

We believe we are not doing enough. To assess for yourself, we ask you to consider the following facts:

In South Africa ,TB kills 31 000 people a year – 84 every day – and there are over 1 400 new infections a day. And most of these deaths are preventable.

MDR and XDR TB is out of control, is causing increased mortality and burdening the health system with high costs. In 2012, 14 161 cases of MDR-TB were diagnosed, and less than half of these were provided with treatment.

MDR TB patients have to take at least 14 600 pills over 2 years (including a painful injectable for six months) – often on an empty stomach. We need access to better regimens.

Current DR-TB regimens fail most people: DR-TB treatments are still largely ineffective, intolerable and unaffordable.

The lag in financing, developing and providing better treatment regimens is unacceptable.

We are failing to properly implement decentralised DR-TB treatment.

We are failing to make the extra effort to diagnose TB in children and provide proper paediatric regimens.

We are failing to closely and continually monitor our efforts on TB and DR- TB.

There is an absence of an effective mass media campaign to promote both TB and DR-TB diagnosis, prevention and treatment.

We are failing to provide psychosocial, nutritional, community and socio-economic support to TB and DR-TB patients.

If you agree and accept the facts above, we ask you to contemplate one final set of critical questions:

– Should TB and DR-TB be declared a public health emergency that requires an extraordinary plan and a ring-fenced, dedicated and properly resourced budget?

– Should a ‘war room’ involving all key stakeholders be set up in every province to ensure focused TB and DR-TB prevention, improved co-ordination for treatment and rapid response teams for identified problem areas such as stock-outs?

– Should the National Department of Health provide quarterly reports to the South African National AIDS Council on a set of crucial indicators, which will be used to assess whether or not we are making meaningful progress against TB and DR-TB?

To overcome TB and DR-TB or to sit back? To help people to live or let them die? The choice is ours.